Provider Demographics
NPI:1558310995
Name:BOHINC, RUDY J (MD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:J
Last Name:BOHINC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WEST MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-497-5678
Mailing Address - Fax:937-497-5671
Practice Address - Street 1:661 N VANDEMARK RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3552
Practice Address - Country:US
Practice Address - Phone:937-419-8010
Practice Address - Fax:937-419-8011
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0725362Medicaid
OHA83118Medicare UPIN
OH0725362Medicaid